Tag Archives: psychiatry

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April 20, 2022

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Anti-Psychiatry now

Attempts to medicalise distress, and the backlash against alternatives

We know that capitalism makes us sick, but there is a deeper more insidious form of this process that we need to get to grips with if we are to find alternatives to the damaging ‘treatments’ that are doled out by mainstream psychiatry.

Psychiatry is often confused with other ‘psy’ disciplines (like psychology, psychotherapy and psychoanalysis), but what marks it out from the others is that it is deliberately and explicitly medical; psychiatry is underpinned by a ‘medical model’ of distress so what we feel when we feel bad is treated by specialist doctors as if it is really a ‘sickness’ that has an physical organic cause that can then be ‘cured’ by physical, usually drug interventions.

What that assumption about sickness and cure does, and it is drummed into the psychiatrist in their medical training before they specialise in ‘mental disorders’, is to effectively ignore the alienation, exploitation, oppression and misery of living under capitalism. The psychiatrist instead is trained to search for the ‘real’ underlying causes, as if poverty, exclusion, austerity, racism and sexism were mere additional factors that might just intensify or ‘trigger’ what the doctor detects underneath the symptoms they are trained to attend to. The fiction that medical psychiatrists really now work according to a ‘bio-psycho-social’ model is a hopeless delusion. When it comes down to it, they reduce distress to biology, or they break with psychiatry.

Doctoring

A psychiatrist, like other medical professionals, is under pressure to make speedy diagnosis, choosing a category from the DSM (the Diagnostic and Statistical Manual of Mental Disorders) or the ICD (International Classification of Diseases), and to administer treatment, and so the reduction of distress to a physical cause is the understandable default procedure. This pressure is added to by the marketing of an increasing number of new ‘disorders’ by the drug companies, and by the promise that symptoms can be dealt with by targeting a chemical imbalance in the brain.

So-called ‘psychopharmacology’ is a massive drug market, legalised and state-sanctioned drug-pushing, and big pharma pours huge investment into identifying disorders that are dampened by drug treatments. That investment includes paying medics to endorse or even add their names as authors to already-written research reports, and it includes smearing those who have second thoughts, whistleblowers and psychiatrists who realise that the medical model just does not work.

In some ways, the approach does work, of course. Symptoms are certainly dampened down by the drugs, and patients are got off the books. And many patients are relieved to be given a diagnosis, to find an answer of some kind to their distress, and to accept what they are handed as a life sentence, that is, to accept that the sickness is deep within them and could return at any time. The illusion that root causes have been found is often a comfort to the patient and, of course, the doctor, but it is disabling.

Contradictions

Yet, from the beginning of psychiatry, which took root as a more humane approach to the mad inside the old asylums at the end of the eighteenth century, there were fierce debates; many early psychiatrists favoured physical treatments – restraint and then, at worst, electroshock and surgery – while some, like the Quakers at the York Retreat, looked to ‘moral treatment’ that included encouragement to get back to work, to work alongside others in the community. The ‘chemical revolution’, discovery of major antidepressents in the 1950s, shifted the field of debate.

The more humane psychiatrists objected to the chemical cosh, just as their predecessors had objected to patients being manacled and put on show. It was then that quite a few psychiatrists broke with psychiatry altogether, and looked for alternatives in a disparate movement that became dubbed ‘anti-psychiatry’. That was a misleading label, covering a wide range of alternative approaches to distress, some inspirations, some dead ends and some real dangers for the poor patients who sometimes had good reason to cling to the labels they had been given.

Some of the most prominent ‘anti-psychiatrists’ hated the label, objected to it, sometimes because they weren’t actually against psychiatry as such at all. One of the most prominent, Thomas Szasz, who appears as the main representative of the tradition in psychiatry and social work textbooks, was a right-wing libertarian, who was against the whole notion of ‘mental illness’ because it let people off the hook; as well as leading to coercive practices, medical psychiatry gave people excuses, he said, for their bad behaviour.

Szasz’s spin on ‘moral treatment’ meant getting people to stand on their own two feet and take responsibility, individual responsibility for what had gone wrong in their lives. He was willing to ally with the scientologists to get his message across. This is neoliberalism in the field of mental health, not a progressive alternative, and recently some other critics of psychiatry have also dabbled with anti-vax and conspiracy theories.

The left

Some on the left fell into the trap of putting a plus where the psychiatrists put a minus, and there was a temptation among some ‘anti-psychiatrists’ to romanticise distress, to make it seem as if madness was a kind of journey to enlightenment. Some of these were ostensibly, for a time, on the left but, like R D Laing, they travelled down a drunken road into quasi-spiritual nonsense, and celebration of the family as a refuge rather than, as they once had it, as a prison.

One of the most radical experiments, in Italy, and one that Laing disparaged as being ‘communist’, was the closure in Trieste of the mental hospital in the early 1980s. This was following a massive campaign by the far left against psychiatric abuse that managed to draw in the communist party and a pre-emptive partial reform of the Italian psychiatric system after a successful referendum. This was a time when mental health really became a political issue, politics involving thousands of people debating and building alternatives in the form of community mental health centres.

That experiment inspired a psychiatrist in Sheffield, Alec Jenner, using money left over from a conference about Trieste, to set up Asylum, which fashioned itself as a magazine for democratic psychiatry. ‘Democratic psychiatry’ had been the name of the reform movement in Italy, also led by a psychiatrist, Franco Basaglia who broke ranks with his medically-trained colleagues.

The magazine hosted innovative work around ‘hearing voices’ developed by yet another psychiatrist Marius Romme. Many people hear voices, and for many different reasons, Romme realised; the task then was to explore what that meant rather than silence the voices, rather than put the experience under a chemical cosh. Meetings organised by Asylum magazine also included another group of rebel doctors in the Critical Psychiatry Network.

Prominent among that new generation of psychiatrists turning against the medical model, effectively becoming ‘anti-psychiatrist’, was Joanna Moncrieff who, in her ground-breaking book The Myth of the Chemical Cure, showed that the psychiatric drugs did not in any way ‘rebalance’ disordered brain processes. Instead, as with alcohol, nicotine or other recreational drugs, the psychiatric drugs changed the chemistry of the brain. That ‘drug-focused’ assumption had actually been guiding research before the so-called chemical revolution of the 1950s, but we need to remember it and follow the consequences if we are to break from the ‘illness-focussed’ assumption that the drug companies base their research and advertising campaigns on.

The battlefield now

All of this brief potted history is to make the point that ‘anti-psychiatry’ is a very mixed enterprise, and that we need many alternatives to the medical model, alternatives that take distress seriously. If we don’t do that, there is a big risk that we will take fright and fall for the lure of bedrock biological explanations. This is where we are now, with recent attempts to rehabilitate the medical model and to reduce the alternatives to caricature. And this is where some on the left who are desperate to find what they think of as being ‘materialist’ explanations for distress seem to be giving ground to the assumptions peddled by big pharma.

If we are materialists, the argument goes, then surely we should acknowledge that at least some of the causal mechanisms to distress are biological, so why not call the problem ‘medical’ in a very broad sense, and if there are such causal mechanisms in the brain what would be wrong in sifting out what causes what and valuing the drugs that do actually make a difference. And, here they twist the knife, it seems very difficult to show exactly how what bits of capitalism or other forms of oppression cause exactly what bits of distress.

This is a version of standard right-wing arguments against Marxism, that because you can’t directly and immediately observe and precisely measure the link between personal distress and oppression, it is not capitalism (or racism’s or sexism’s etc) fault. Work on the ‘spirit level’ that shows that inequality in society is correlated with unhappiness goes some way to addressing that, but we need a deeper more radical practical-theoretical understanding of capitalism to keep ourselves grounded in the possibility of alternatives, and not only in the field of mental health.

We’ve seen the medical line of argument, an attempt within the left to roll back critiques of psychiatry, a couple of years ago, in 2020, and there have been good responses to that psychiatric backlash by radicals.

The dice are loaded against us because, it is true, there is something inexplicable about distress that cannot be simply ‘diagnosed’ – whether that is depression or more profound alienation labelled, in the medical model, ‘schizophrenia’ – and we have been unable to construct societies in which we can give people space – genuine ‘asylum’ that the democratic psychiatry and critical psychiatry movements called for – and access to real care.

Instead, the randomised controlled trials, between effects of drugs and ‘placebos’, are all against the background of a rotten society; the ground-rules mean that a base-line ‘biological’ cause becomes as tempting an answer as the possession by demons was convincing to religious folk way back before the asylums were built. Friends and comrades involved in supporting people in distress are desperate to get out of this predicament, but over and again they lose hope that things could ever change dramatically enough to rule out drug treatment. In the meantime, they say, we need to patch people up, and hope for better psychiatric research; this is desperate, understandable, but a mistake that gives ground to psychiatry.

Alternatives

As with every other challenge to the power of institutions under capitalism, vested interests tell us that the fault is in ourselves instead of in society, we need to acknowledge that people need to find ways to cope, but the way they do that has to be collective, which means, short-term, supporting patients subjected to medical treatments to share information and weigh up what they want to accept and what they cannot. That collective agency was the basis of the ‘hearing voices’ movement – groups of people exploring what their voices meant to them – which ‘de-medicalised’ that experience, took it out of the hands of the doctors to define what was normal and what was abnormal.

It also means working with those who have broken and are still are breaking with psychiatry, to expose the research agendas of the pharmaceutical companies. Yes, we can imagine that under other conditions, resources could be put into exploring what drug treatments might help, but that means looking at what works in line with a ‘drug-focused’ model rather than buying into the idea that there is an underlying illness that needs to be cured. Meantime we need to focus on the question of power and on building radical clinical alternatives rather than digging about in the brain. And that means supporting those who are breaking from psychiatry inside the mental health care services.

It is the search for a cure for this wretched miserable society that needs to take priority now, and that collective process is one that can give hope, channel energy and enthusiasm, give meaning for people who are usually labelled as ‘crazy’ or ‘sick’ or ‘abnormal’. The apparently ‘balanced’ and ‘neutral’ arguments about what might be happening in the brain for people who are in distress are not really ‘balanced’, any more than is the fiction of chemical ‘rebalancing’ in pharmaceutical propaganda, and they are not ‘neutral’.

Good research is not neutral, but knows what choices are being made, and why, and in line with what agendas. The medical model locks people into their distress, into their biology, while we need to be finding a way out of it, together.

You can read and comment on this article where it was originally published here

This is also part of the FIIMG project to put psychopolitics on the agenda for liberation movements

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April 27, 2017

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Mad to be Normal

A new film about R D Laing should be something for the left to watch and learn from, about the politics of madness and the connection between different forms of liberation. But you won’t find any of that in Mad to be Normal which stars David Tennant reincarnated in some place called ‘the sixties’ as Dr Ronnie. Most of the action is set at Kingsley Hall, the alternative non-medical facility directed by Ronnie Laing in East London from 1965 to 1970, though a poster in Ronnie’s bedroom – that’s where he beds a composite character American student besotted with his work – is of the Dialectics of Liberation conference which took place in July 1967, so we are actually in a very compressed time-scale in Laing’s medical and anti-psychiatric celebrity career.

There is a heck of a lot of ‘acting’ going on in this film, and ‘mad’ people have often provided good fodder for thespians wanting to try out their skills at challenging notions of normality. The funniest moment is when two old thesps, Gabriel Byrne and Michael Gambon, have a muddled conversation, and it is funny not because they are good at playing crazy but because it is difficult not to imagine them chuckling away to each other during rehearsals. The shame is that, apart from Ronnie’s valiant efforts to spring one of his patients from a psychiatric hospital towards the end of the film, there is plenty of play-acting and very little actual resistance to power in the film. This makes it very different from the classic One Flew over the Cuckoo’s Nest, for example, where at least there is rebellion by the patients themselves against the institution.

The sequence of vignettes – patients doing stereotypically mad things, Laing behaving badly, traditional psychiatrists enraged to the point of closing down Kingsley Hall – strip out the history of Laing’s evolution from undergoing medical training, to training as a psychoanalyst, realising that patients are more than bundles of chemical reactions, searching for alternatives, linking with other liberation movements, raging against the nuclear family, finding Eastern religion, and then celebrating the family again before dying of a heart attack while playing tennis in St Tropez. We have nothing of the work of the therapists who worked with an argued with Laing in the organisations he founded, and nothing of the legacy of those debates in the present-day radical training organisation the Philadelphia Association.

And, apart from the Dialectics of Liberation conference poster, there is nothing of the political context for that resistance against medical power. One of the characters in the film is a young Black man who has been diagnosed with paranoid schizophrenia and subjected to Electroconvulsive therapy (ECT) – electroshock that has seen an over ten percent rise of use in the last ten years and which is given disproportionally to Black people (and elderly women). His parents bring him to Kingsley Hall, running the gauntlet of hostile locals who stand outside the main entrance taunting the residents. It seems odd that there is no mention at any point that this guy is Black, no discussion of the racism that pervades mental health services, but then, there is no mention of either racism or sexism or the conditions that cause distress.

At his most radical moments – and, yes, these were limited – Laing did, at least, begin to indict alienation under capitalism as a factor in distress, that’s why he was invited to the Dialectics of Liberation conference to speak alongside Stokely Carmichael and Herbert Marcuse. In this respect, he was very different from the right-wing libertarians like Thomas Szasz who argued both against psychiatric coercion and what he called ‘psychiatric excuses’. And Laing was much more cautious than those who were always on the left such as Franco Basaglia, founder of Democratic Psychiatry in Italy (Basaglia, who Laing, toward the end of his career, attacked for being an anti-family Marxist). Why the anti-psychiatry movement should have developed is a mystery in this film, with some suggestion, instead, that poor pathetic Ronnie never got over the death of his dad.

The film warns us that none of the characters depicted in the film have any relationship with actual people, living or dead, and it is tempting to apply that warning to Laing himself. Tennant does a good job on his hesitant drunk narcissistic drawling when surrounded by admirers and there are occasional hints of his charismatic humane approach to people in distress, but this Laing is a one-dimensional snapshot of a much more complicated figure in the history of resistance to mainstream medical psychiatry. I went into the cinema wishing I had taken packs of leaflets for the Asylum Democratic Psychiatry conference, but by the end I was relieved that I had not, for this was a film that does not do revolutionary politics any favours, for what it omits as much as what it portrays. This film evokes a mythical folk character, a time and movement, reducing them to caricature. This is one doctor to avoid.

If you liked the film or thought it was even worse, you can read this article and comment on it here

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February 14, 2017

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Post-Truth and Paranoia: Action, Reaction and Asylum

The last time round that the world was on the brink of self-destruction, the Marxist psychoanalyst Joel Kovel (and one-time candidate for the US Green Party presidential race) wrote a classic book on collective fear called ‘Against the State of Nuclear Terror’. The book was first published in the UK in 1984 linked to a Channel Four programme in the ‘Science in Society’ series (led by psychoanalytic Marxist Robert M Young) and then revised and republished in the US in 1999. Kovel’s analysis is still a useful starting point for thinking about what we are going through today with Trump as US President, but there are some nastier twists and turns in the last years that have made Kovel’s diagnosis of ‘paranoia’ even more relevant and even more dangerous to the left.

Kovel’s argument was that what seemed like the imminent destruction of the world through the nuclear arms race between the United States and the Soviet Union induced a sense of helplessness and ‘paranoia’. This paranoia is very like the state of mind that psychiatrists think they can diagnose inside individuals – their sense that they are under threat and an attempt to identify enemies – but the difference is that the ‘state of nuclear terror’ was primarily a social process and it was then experienced by individuals who then shut themselves off from others in order to cope with that unbearable threat. Kovel, who was trained first as a medical psychiatrist before turning to psychoanalysis (something he then abandoned when he became a full-time political activist), thus turned psychiatry on its head. The problem did not lie inside individuals or their bad brain chemistry, but in political organisation.

Destructive political organisation, as in the times of the state of nuclear terror, led people to protect themselves and become more ‘individual’ than they had ever been before, and that ‘solution’ to distress was, of course, part of the problem. Kovel argued that the left needed to rethink its hierarchical forms of organisation and so find a way out of this individualist terrorised frame of mind. He argued for ‘affinity groups’ in which people could share their fear and work through it together, in the process discovering for themselves what the truth was about the world, about themselves and about forms of collective resistance. In this way they could understand the world through changing it.

This political analysis, and the options Kovel laid out as alternatives, relied on us taking a step back from the lies told by the United States military and the Soviet leadership. The arms race as a form of ‘Mutually Assured Destruction’ (MAD) could only be tackled by declaring a plague on the houses of both sides, or, what was crucial, a plague on the masters of those houses. Truth would be something that would be discovered or constructed in the process of political mobilisation from the grassroots, and only this process would enable people to bit by bit trust each other as they started to trust their own responses to threat, to see those responses as clues to what was being done to them rather than as ‘symptoms’ of something wrong about them that could be patched up by a psychiatrist.

Now, in times of ‘post-truth’, 2016’s word of the year in the UK – a pernicious corrosion of trust in accounts of the world that then works its way into individuals so that they distrust others and distrust themselves – we are in a much more dangerous political situation. Trump is the symptom of that. Trump is the symptom not because he is a narcissistic or paranoid or bi-polar basket case – that way of approaching the problem will land us in a worse mess than we are in at the moment – but he functions as a symptom of ‘post-truth’ as a paranoid twisted universe of meaning that drives people into themselves away from politics, and then drives people mad as they lose any compass for finding their way around the world.

The attempt to ‘diagnose’ Trump using psychiatric categories is a dead-end, not only because we cannot possibly know what is going on inside his head – even a clinician working with him full-time over a long period of time would find that difficult – but also because the psychiatric categories we might grab hold of to reassure ourselves that we know why the real bad guy is really bad are themselves suspect and use of them will rebound and cut against us. Playing the diagnosis game de-politicises what is going on, and it reinforces the power of those, the psychiatrists, who deliberately or unwittingly (who knows, some psychiatrists do what they do with the best of intentions perhaps) divide us from each other and drug us and shock us to bring us into line with reality again, adapts us to bad reality, the reality that says there is no way of resisting, no way of changing the world.

To understand how potent ‘post-truth’ is to the Trump effect, and to the forms of paranoia it provokes across the political symbolic field, we need to understand where we are in historical-political context. The fall of the Soviet Union disoriented a generation of leftists, not only those who thought that Stalin, Brezhnev and Co. were the bees knees and that socialism was being built there, but also many leftists who had refused to accept that the Soviet Union had anything to do with socialism and that there needed to be a ‘political revolution’ to overthrow the bureaucracy that would be as far-reaching as a revolution in the West. The new regime in Russia under Putin has played on this disorientation, and in a very canny way, not by instituting a new regime of truth – not by the old fixed coordinates which would replace one symbolic reality of old socialism with a new one geared to the capitalist empire that now exists in Russia – but by corroding the ability of people to distinguish between truth and lies.

Putin has relied on a series of advisors to do this, and has succeeded in dissolving the difference between truth and reality by feeding into the public media, which is controlled by Putin, a variety of contradictory accounts of what is going on. The point of this, or at least let’s say the effect of this, is that ‘information’ as such becomes inseparable from propaganda, and people at some level know this. This is what we could call ‘the state of information terror’ in which the only reasonable response is paranoia. Now, leaving aside whether Putin interfered or not with Trump’s election as US President, this approach to ‘truth’ – that is, contempt for truth as a value as such – is something that Trump has made use of. Putin’s misogyny also chimes with Trump’s, as can be seen in the Duma motion to decriminalise domestic violence. It bears fruit first in the so-called ‘alt-right’ and then in Trump’s world of ‘alternative facts’. This a dangerous political process in which many of the left are so desperate for an alternative, for truth, that, even though they might even have come from political traditions that were once critical of the Soviet Union when it claimed to be socialist, they now unbelievably side with one ‘camp’ – the enemy of their enemy and then swallow whole all that the state propaganda machine in Moscow spews out. There is a twist here not only on Kovel’s ‘State of Nuclear Terror’ but also on neoliberalism as an individualising ideology that was beginning to take form back in the 1980s.

Neoliberalism rests on three elements that lock us into capitalism and then leaving us, it often seems and feels, with nowhere to hide. The shift to individual responsibility, first element, runs alongside the destruction of the welfare state, as the second element, and the imposition of a strong state, a third key element which is sometimes neglected in cultural analyses of neoliberalism. You have a check-list here of what Putin has done in Russia, and what Trump is doing in the US now. And that also means not only that many ‘alternative’ sites of information, the string of news outlets controlled by the Kremlin as a case in point, are devoted to misinformation, but also that we are each being driven into our individual selves, little mini-states, little prisons of the self; the uncertainty and misery becomes internalised, and the drive to internalise all that stuff is precisely part of the trap.

Kovel’s alternatives in the 1980s and 1990s relied on therapeutic work that would make the ‘affinity groups’ into places where the ‘personal’ and the ‘political’ would be linked together again, the ‘personal’ and the ‘political’ parts of our lives that are torn apart by our life under capitalism, and that are often, unfortunately torn apart by many left groups who don’t understand that capitalism is both a political-economic system and a ‘state of mind’ in which we are alienated from each other and alienated from ourselves. Today, with the destruction of mental health welfare services and the use of therapy by the state to force people back to work, it is all the more important to connect personal and collective distress through forms of self-organisation. It is not as if these attempts do not exist. The pity is that these alternatives are often ignored by the left. We can learn about these attempts to link the personal and the political from feminism, and also from radical mental health practice. There are hundreds of ‘Hearing Voices Groups’ in the UK, for example, that enable people to find alternatives to the pathologising victimising work of medical psychiatry. There are networks of activists, and ex-activists, for example, who participated in the formation of a ‘Paranoia Network’ which refuses medical diagnosis of what is, at root, a political problem. And there are many local groups operating as ‘mad women’ or ‘mad pride’ who reclaim their anger and channel it into protest. They do what the Socialist Patients Collective argued in Heidelberg many years ago, that we should ‘turn illness into a weapon’.

There are networks of the networks that the left needs to engage with, needs to participate in, such as the Asylum Magazine for Democratic Psychiatry which began as a news-sheet for psychiatric users and has, over the years, been central to the formation of the Hearing Voices Network in the late 1980s, to the Paranoia Network at a first national conference it facilitated in Manchester in 2004. Asylum, which was inspired by the movement Psichiatria Democratica in Italy in the 1980s, a movement which closed the medical mental hospitals, has organised many conferences in Manchester, the latest of which will be the 30-year celebration of the magazine in the ‘Asylum: Action and Reaction’ conference on 28 June 2017. Asylum over the years has consistently argued and mobilised against ‘the state of psychiatric terror’ that makes many people who want to speak out against the political manipulation that they experience keep quiet for fear of being medicated or locked up. There is truth in these experiences, not always direct and immediate, but, as is the case for all of our struggles against alienation, exploitation and oppression under capitalism, that truth can only be discovered, rebuilt through collective organisation.

This is a task for the left, a task that necessarily entails working with Asylum and with a range of other alternative mental health activist organisations. Being part of the June Asylum conference would take a step forward to building truth again against a paranoiac post-truth world.

 

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